A copy of medical record will cost you

HEALTH CARE INDUSTRIES

Your new doctor wants to review your medical history? You need proof of what your surgeon did to convince an insurance company to pay the bill? In today's marketplace, "you could spend $400 to $500 compiling a complete medical history to try to convince Blue Cross and Blue Shield to pay a bill," says Nicole Schultheis, an attorney who specializes in women's health issues.

In the past few years, a new industry has moved into Maryland to copy medical records for hospitals. And as more and more people switch insurance companies and doctors, they are finding themselves with unexpected and large bills to move records.

The arrangement is attractive to hospitals because the copying companies give them back part of a "facilities retrieval fee" they charge patients. The hospitals then use their share -- usually between $9 and $15 a patient -- to pay the salary of an employee who enforces privacy laws and gives approved records to the company for copying.

North Arundel Hospital, a 329-bed facility in Glen Burnie, doesn't make a profit from the service. But it has been able to eliminate one employee and pay the salary of a second with fees it obtains from the copying company, said spokeswoman Alison Tavik. She said North Arundel's fees are among the lowest in the area -- $10 for the first seven pages. Half of the fee is returned to the hospital. It handles 30 to 50 requests each day, collecting up to $65,000 in fees annually.

But costs can be much higher. Under some arrangements a 74-page document can cost $114 -- $1 a page, a $10 "facilities retrieval fee" plus shipping, handling and postage. According to Ms. Schultheis, bills are rarely under $200. "I have cases where a copy of the X-ray cost almost as much as it did to do the X-ray," she said.

Consider the case of a woman who had a chronic disease for 10 years, changed insurance companies, had to change doctors, and was forced to provide a record of her treatment to her new doctor. "Her medical record amounted to 400 pages and they wanted to charge her $3 a page," said Kevin Simpson, head of the consumer health division of the state Attorney General's Office. He suggested she sift through the records to see if the entire $1,200 file was vital.

There was little else he could do. The law says medical providers, while required to provide the records, can charge a reasonable fee. But it doesn't define what's reasonable. "Some people call up and complain because they are being charged $1 a page," Mr. Simpson said. "I say, 'You're lucky.' Consumers generally feel they paid for the care and that [providing records] should be part of the care."

This year, worried about the high number of state employees switching insurers, the Attorney General's Office signed on as a co-sponsor of bills in the General Assembly to cap per-page charges. One would set the fee at 50 cents a page. Another would tie fees to those charged by many state agencies. (Under such an arrangement the cost of the 74-page document would drop to $17.76.)

The bills are opposed by the Maryland Hospital Association and some doctor groups. MHA members are now trying to determine how much they need to charge to recover their costs, said MHA Senior Vice President Nancy M. Fiedler. The assessment isn't complete but, according to Ms. Fiedler, it's not 25 cents a page.